目的:分析重庆医科大学附属第二医院解脲支原体(U. urealyticum, Uu)和人型支原体(M. hominis, Mh)引起的泌尿生殖道感染特点及其耐药变化情况,为临床用药和防治提供参考。方法:选取2015~2020年我院39,069例支原体培养和药敏结果进行回顾性统计分析。结果:39,069例患者标本中(女性34,678例、男性4391例),支原体阳性标本21,031例,总检出率为53.83%,女性阳性标本19,444例,检出率56.07%,男性阳性标本1587例,检出率36.14%。其中单纯Uu感染16,292例、Uu + Mh混合感染4731例、单纯Mh感染8例。药敏结果表明,支原体对交沙霉素、美满霉素、强力霉素、克拉霉素敏感率高,分别为97.4%、96.5%、96.1%、94.8%。对氧氟沙星、司帕沙星、左旋氧氟沙星耐药率高,分别为63.5%、47.9%、42.8%。结论:本院泌尿生殖道支原体感染检出率较高,单纯Uu感染为主,敏感抗生素以交沙霉素、美满霉素、强力霉素、克拉霉素为主,耐药抗生素以喹诺酮类为主,其中交沙霉素可作为本院支原体感染治疗的首选药物。 Objective: To analyze the characteristics and drug resistance changes of urogenital tract infection caused by U. urealyticum (Uu) and M. hominis (Mh) in the Second Affiliated Hospital of Chongqing Medical University, and to provide reference for clinical medication and prevention. Methods: A retrospective statistical analysis was conducted on the culture and drug sensitivity of 39,069 my-coplasma patients in our hospital from 2015 to 2020. Results: Among 39,069 patients (34,678 fe-males and 4391 males), there were 21,031 mycoplasma positive specimens, with a total detection rate of 53.83%, 19,444 female positive specimens with a detection rate of 56.07%, and 1587 male positive specimens with a detection rate of 36.14%. There were 16,292 cases of simple Uu infection, 4731 cases of mixed Uu + Mh infection and 8 cases of simple Mh infection. The sensitivity of mycoplasma was 97.4%, 96.5%, 96.1% and 94.8%, respectively, to josamycin, minocycline, doxycycline and clarithromycin. The drug resistance rates of ofloxacin, sparfloxacin and levofloxacin were 63.5%, 47.9% and 42.8%, respectively. Conclusion: The detection rate of mycoplasma infection in urogenital tract in our hospital is high, and simple Uu infection is the main infection. The sensitive antibiotics are mainly josamycin, marvelmycin, doxycycline and clarithromycin, while the resistant antibiotics are mainly quinolones, among which josamycin can be used as the first choice for the treatment of mycoplasma infection in our hospital.
目的:分析重庆医科大学附属第二医院解脲支原体(U. urealyticum, Uu)和人型支原体(M. hominis, Mh)引起的泌尿生殖道感染特点及其耐药变化情况,为临床用药和防治提供参考。方法:选取2015~2020年我院39,069例支原体培养和药敏结果进行回顾性统计分析。结果:39,069例患者标本中(女性34,678例、男性4391例),支原体阳性标本21,031例,总检出率为53.83%,女性阳性标本19,444例,检出率56.07%,男性阳性标本1587例,检出率36.14%。其中单纯Uu感染16,292例、Uu + Mh混合感染4731例、单纯Mh感染8例。药敏结果表明,支原体对交沙霉素、美满霉素、强力霉素、克拉霉素敏感率高,分别为97.4%、96.5%、96.1%、94.8%。对氧氟沙星、司帕沙星、左旋氧氟沙星耐药率高,分别为63.5%、47.9%、42.8%。结论:本院泌尿生殖道支原体感染检出率较高,单纯Uu感染为主,敏感抗生素以交沙霉素、美满霉素、强力霉素、克拉霉素为主,耐药抗生素以喹诺酮类为主,其中交沙霉素可作为本院支原体感染治疗的首选药物。
泌尿生殖道,支原体感染,药敏分析,耐药变化
Guoshuang Xue*, Zhengai Xiong#, Yonghong Zhang, Chengyang Tang
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing
Received: Mar. 14th, 2022; accepted: Apr. 8th, 2022; published: Apr. 18th, 2022
Objective: To analyze the characteristics and drug resistance changes of urogenital tract infection caused by U. urealyticum (Uu) and M. hominis (Mh) in the Second Affiliated Hospital of Chongqing Medical University, and to provide reference for clinical medication and prevention. Methods: A retrospective statistical analysis was conducted on the culture and drug sensitivity of 39,069 mycoplasma patients in our hospital from 2015 to 2020. Results: Among 39,069 patients (34,678 females and 4391 males), there were 21,031 mycoplasma positive specimens, with a total detection rate of 53.83%, 19,444 female positive specimens with a detection rate of 56.07%, and 1587 male positive specimens with a detection rate of 36.14%. There were 16,292 cases of simple Uu infection, 4731 cases of mixed Uu + Mh infection and 8 cases of simple Mh infection. The sensitivity of mycoplasma was 97.4%, 96.5%, 96.1% and 94.8%, respectively, to josamycin, minocycline, doxycycline and clarithromycin. The drug resistance rates of ofloxacin, sparfloxacin and levofloxacin were 63.5%, 47.9% and 42.8%, respectively. Conclusion: The detection rate of mycoplasma infection in urogenital tract in our hospital is high, and simple Uu infection is the main infection. The sensitive antibiotics are mainly josamycin, marvelmycin, doxycycline and clarithromycin, while the resistant antibiotics are mainly quinolones, among which josamycin can be used as the first choice for the treatment of mycoplasma infection in our hospital.
Keywords:Urogenital Tract, Mycoplasma Infection, Drug Sensitivity Analysis, Resistance to Change
Copyright © 2022 by author(s) and Hans Publishers Inc.
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支原体是一类无细胞壁、形态多样原核细胞型微生物,直径较小,是目前发现的最小微生物。其中解脲支原体(U. urealyticum, Uu)、人型支原体(M. hominis, Mh)、生殖支原体(M. genitalium, Mg)是与泌尿生殖道感染有关的常见支原体。生殖支原体自上个世纪80年代才被人们发现,且受检测条件所限,Mg仅在我国极少数医院开展检测 [
1) 一般资料:选取采自2015~2020年重庆医科大学附属第二医院妇产科、生殖中心、肾内科、泌尿外科、风湿免疫科等就诊的疑为泌尿生殖道感染的39,069例患者的泌尿生殖道标本。
2) 试剂:支原体分离、鉴定、药敏检测板(微生物检验法),购自珠海市丽拓生物科技有限公司(粤械注准20152401219)。
3) 仪器:隔水式电热恒温培养箱(上海跃进医疗器械有限公司,标准号:YZB/沪0938-41-2005)。
1) 标本采集方法:男性:消毒患者尿道口,拭子缓慢插人尿道口2~4 cm轻轻旋转1周,停留10~20 s取出。女性:消毒患者外阴,棉球将外阴、阴道及宫颈口分泌物擦干(使宫颈口处不可有黏性分泌物)拭子插入宫颈口1~2 cm轻轻旋转数次取出。标本采集后均置无菌试管内立即送检。
2) 检测方法:采用上述支原体分离、鉴定、药敏检测板,操作和结果读取由专人严格按照试剂盒说明书进行。
3) 统计学方法:采用SPSS19.0统计学软件进行统计学分析结果。
39,069例患者标本中支原体阳性标本21,031例,总检出率为53.83%,女性阳性标本19,444例,检出率56.07%,男性阳性标本1587例,检出率36.14%,女性患者感染支原体阳性率与男性感染支原体阳性率差异具有统计学意义(P < 0.05)。其中单纯Uu感染16292例、Uu + Mh混合感染4731例、单纯Mh感染8例,见表1。
性别 | 例数 | Uu | Mh | Uu + Mh | 合计 |
---|---|---|---|---|---|
男 | 4391 | 1377 (31.36%) | 0 | 210 (4.78%) | 1587 (36.14%) |
女 | 34,678 | 14,915 (55.97%) | 8 (0.02%) | 4521 (13.04%) | 19,444 (56.07%) |
合计 | 39,069 | 16,292 (41.70%) | 8 (0.02%) | 4731 (12.11%) | 21,031 (53.83%) |
表1. 39,069例患者支原体检测情况(n%)
注:男女阳性率比较,P < 0.05。
支原体感染患者年龄集中在20~40岁阶段,感染率为40.98%,占总阳性的77.99%,见表2。
年龄 | 检查例数 | 阳性例数(占总阳性%) | 感染率(%) |
---|---|---|---|
21~30岁 | 14,607 | 8193 (38.96) | 20.97 |
31岁~40岁 | 15,315 | 8209 (39.03) | 20.01 |
41岁~50岁 | 6308 | 3522 (16.75) | 9.01 |
50岁以上 | 2549 | 925 (4.4) | 2.4 |
表2. 39,069例泌尿生殖道支原体感染人群年龄分布(n%)
对21,031例泌尿生殖道支原体阳性标本进行10种抗生素敏感性及耐药性测定,结果显示:单纯Uu感染对10种抗生素的敏感率:交沙霉素 > 美满霉素 > 强力霉素 > 克拉霉素 > 四环素 > 罗红霉素 > 阿奇霉素 > 司帕沙星 > 左旋氧氟沙星 > 氧氟沙星;耐药率:氧氟沙星 > 司帕沙星 > 左旋氧氟沙星 > 罗红霉素 > 四环素 > 阿奇霉素 > 克拉霉素 > 强力霉素 = 美满霉素 > 交沙霉素,差异具有统计学意义(P < 0.05)。Uu与Mh混合感染对10种抗生素的敏感率:交沙霉素 > 美满霉素 > 强力霉素 > 四环素 > 克拉霉素 > 罗红霉素 > 阿奇霉素 > 司帕沙星 > 左旋氧氟沙星 > 氧氟沙星,耐药率:氧氟沙星 > 司帕沙星 > 左旋氧氟沙星 > 罗红霉素 > 阿奇霉素 > 克拉霉素 > 四环素 > 强力霉素 > 美满霉素 > 交沙霉素,差异具有统计学意义(P < 0.05)。单纯Mh感染对10种抗生素的敏感率:强力霉素 = 美满霉素 > 四环素 = 左旋氧氟沙星 > 阿奇霉素 = 司帕沙星 > 交沙霉素 > 克拉霉素 = 氧氟沙星 = 罗红霉素;耐药率:只有对克拉霉素耐药率为12.5%,对其余9种抗生素耐药率为0,由于本实验单独Mh感染仅8例,在小样本分析上有很大的局限性。当Uu与Mh混合感染时,对10种抗生素敏感率比单纯Uu感时染低,耐药率比单纯Uu感染时高,差异具有统计学意义(P < 0.05)。结果见表3。
药物名称 | Uu (n = 16,292) | Uu + Mh (n = 4731) | Mh (n = 8) | ||||||
---|---|---|---|---|---|---|---|---|---|
S | I | R | S | I | R | S | I | R | |
阿奇霉素AZI | 31.0 | 64.2 | 4.7 | 11.9 | 26.3 | 61.6 | 62.5 | 37.5 | 0.0 |
克拉霉素CLA | 94.8 | 3.8 | 1.2 | 34.4 | 8.2 | 57.3 | 25.0 | 62.5 | 12.5 |
交沙霉素JOS | 97.4 | 2.3 | 0.2 | 88.9 | 6.6 | 4.4 | 50.0 | 50.0 | 0.0 |
罗红霉素ROX | 40.8 | 53.2 | 5.8 | 13.7 | 23.5 | 62.7 | 25.0 | 75.0 | 0.0 |
强力霉素DOX | 96.1 | 3.1 | 0.7 | 86.6 | 8.6 | 4.6 | 87.5 | 12.5 | 0.0 |
美满霉素MIN | 96.5 | 2.6 | 0.7 | 87.7 | 7.6 | 4.5 | 87.5 | 12.5 | 0.0 |
四环素TET | 82.3 | 12.6 | 5.0 | 68.5 | 18.4 | 13.0 | 75.0 | 25.0 | 0.0 |
左旋氧氟LEV | 12.6 | 44.4 | 42.8 | 4.4 | 29.1 | 66.4 | 75.0 | 25.0 | 0.0 |
氧氟沙星OFL | 7.4 | 28.9 | 63.5 | 2.2 | 17.2 | 80.4 | 25.0 | 75.0 | 0.0 |
司帕沙星SPA | 13.2 | 38.8 | 47.9 | 5.1 | 23.1 | 71.6 | 62.5 | 37.5 | 0.0 |
表3. 39,069例泌尿生殖道支原体耐药率及敏感率情况统计(%)
1) 支原体分类:1898年Nocard等首次从牛传染性胸膜肺炎病灶中发现了支原体,1973年Dienes等从前庭腺炎患者脓液中分离出第一株人源性支原体,1962年Chanock等采用人工培养基培养支原体获得成功。支原体在生物分类学上属于柔膜体纲(Mollicutes)支原体目(Mycoplasmatales)支原体科(Mycoplasmataceae)。支原体科含支原体(Mycoplasma)和脲原体(Ureaplasma)两个属。支原体属有150余种,脲原体属有6种,对泌尿生殖道致病的主要有解脲脲原体(U. urealyticum, Uu)、人型支原体(M. hominis, Mh)、生殖支原体(M. genitalium, Mg)。其中解脲脲原体又可分为两个亚型:Parvo生物型和T960生物型,因培养这两种亚型所形成的菌落外观一致,故需依据基因组之间的差异采用核酸检测的方法加以区分。
2) 支原体检测:检测生殖道支原体主要包括培养法、免疫法和分子生物法三种手段,我国医疗机构目前主要采用培养法进行解脲脲原体和人型支原体检测。单纯的液体培养法具有操作简便、可同时进行药敏试验的优点,但因其仅是一种生化鉴定,不能准确判断有无支原体感染及无法做到纯分离,使固体培养法结合显微镜观察成为判定支原体感染阳性的“金标准” [
3) 结果:a) 本研究中支原体感染率,Uu > Uu + Mh > Mh (P < 0.05),显示本院支原体感染以Uu为主,与国内外的报道一致 [
4) 意义:目前支原体感染被认为与不良妊娠结局有重要关系,但国内很多临床医生对于支原体的致病性及该如何治疗认识混乱。在2016年发表的《生殖道支原体感染诊治专家共识》 [
5) 局限性实验选取时间窗较短,未能更好地体现出数据的变化,减少了对临床用药的针对性指导意见,为不足之处。
薛国爽,熊正爱,张永红,唐成杨. 39,069例泌尿生殖道支原体培养及药敏结果分析Analysis on the Culture and Drug Sensitivity of 39,069 Cases of Urogenital Mycoplasma[J]. 临床医学进展, 2022, 12(04): 2807-2812. https://doi.org/10.12677/ACM.2022.124402